Sylvania Application – Claxton Poultry Farms

Claxton Poultry – Sylvania Plant – Job Applicant Information

Date

Name *

First

Middle

Last

Social Security Number *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Email

Date of Birth *

Can You Provide Proof of Age?

If hired can you furnish proof of age?

Emergency Contact

In case of emergency, notify

Address

Emergency Contact Address

Phone

Emergency Contact Phone Number

Drivers License

Do you have a valid motor vehicle operator’s license?

License Revoked?

Has it ever been revoked?

Drivers License Revoked

If your license has been revoked please explain

Single Line Text

Do you have another job or “sideline” business? If so state type of business or job and hours you work at your own business or other job.

Single Line Text

What family or other responsibilities might affect your attendance?

Education and Service

Name & Location – Highest Grade Completed & What Year

Grade School

High School

College

Other Skills

Other skills or special training

Military Service

Branch – Rank – Date Entered – Date Discharged – Duties While In Service

Reserve or National Guard

Yes
No

Are you a member of the Reserve or National Guard?

Stand-by or Ready?

Employment Desired

Position Applying For

Wage Desired

Date You Can Start

How would you get to work?

Shifts willing to work

Can You Work Full-Time or Part-Time?

Full Time
Part Time
Either

If Part-Time, what days & hours?

Overtime

Are you willing to work overtime and Saturdays if required?

Names of friends and relatives employed here

Have you ever applied to or been employed by this company?

Yes
No

Background Information

Have you ever been convicted of a felony?

Yes
No

If Yes, explain in detail

May we contact your present employer?

Yes
No

If now employed why do you desire a change?

Have you ever been discharged or forced to resign from any job?

Yes
No

If so, explain

Have you drawn unemployment insurance in the past year?

Yes
No

If so, date & amount of last benefit check

Former Employers

List Below Last Three Employers, Starting With Last One First

Prior Employer 1

Name, Address & Phone Number of Employer

Start Date

Date/Month/Year Employment Started

End Date

Date/Month/Year Employment Ended

Wages Per Hour

Average per Week

Position

Reason for Leaving

Prior Employer 2

Name, Address & Phone Number of Employer

Start Date

Date/Month/Year Employment Started

End Date

Date/Month/Year Employment Ended

Wages Per Hour

Average per Week

Position

Reason for Leaving

Prior Employer 3

Name, Address & Phone Number of Employer

Start Date

Date/Month/Year Employment Started

End Date

Date/Month/Year Employment Ended

Wages Per Hour

Average per Week

Position

Reason for Leaving

References

Give the name, address and occupation of three persons (not former employers or relatives)

Reference 1

Reference 2

Reference 3

Confirmation

Date

Signature of Applicant *

Witness